Provider Demographics
NPI:1659681450
Name:WEIDNER, ROSEMARY MORAN (LADC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:MORAN
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03444-0080
Mailing Address - Country:US
Mailing Address - Phone:603-563-8620
Mailing Address - Fax:
Practice Address - Street 1:65 GERRY RD.
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NH
Practice Address - Zip Code:03444-0080
Practice Address - Country:US
Practice Address - Phone:603-563-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)